Comparison of four methods for quantitative assessment of 99mTc-MDP SPECT in patients with suspected condylar hyperplasia | Revista Española de Medicina Nuclear e Imagen Molecular (English Edition)

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Para cada cóndilo se seleccionó la imagen con mayor actividad y se dibujó una ROI de tamaño fijo (1,76 cm2) en ambas cabezas condilares, para obtener las cuentas máximas, el número de píxeles y las cuentas promedio." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D.F. López Buitrago, J.M. Muñoz Acosta, R.A. Cárdenas-Perilla" "autores" => array:3 [ 0 => array:2 [ "nombre" => "D.F." "apellidos" => "López Buitrago" ] 1 => array:2 [ "nombre" => "J.M." "apellidos" => "Muñoz Acosta" ] 2 => array:2 [ "nombre" => "R.A." 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PET/CT at diagnosis showing primary tumor (47mm in diameter and SUVmax 13.7), right axillary lymph nodes (13mm and SUVmax 5.1) and adrenal, liver, ipsilateral lung and bone metastases. Histopthologic lymph node metastases were confirmed. (a) MIP. (b) Coronal PET (white arrow ALM). (c) Coronal fusion. (d) Coronal CT (white arrow ALM). (e) Lymph node metastasis of SCLC (red arrow: necrosis, blue arrow: small cell carcinoma)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Funda Üstün, Burcu Tokuc, Ebru Tastekin, Gülay Durmuş Altun" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Funda" "apellidos" => "Üstün" ] 1 => array:2 [ "nombre" => "Burcu" "apellidos" => "Tokuc" ] 2 => array:2 [ "nombre" => "Ebru" "apellidos" => "Tastekin" ] 3 => array:2 [ "nombre" => "Gülay" "apellidos" => "Durmuş Altun" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X18300738" "doi" => "10.1016/j.remn.2018.09.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X18300738?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S225380891830106X?idApp=UINPBA00004N" "url" => "/22538089/0000003800000002/v1_201903020621/S225380891830106X/v1_201903020621/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2253808919300023" "issn" => "22538089" "doi" => "10.1016/j.remnie.2018.10.018" "estado" => "S300" "fechaPublicacion" => "2019-03-01" "aid" => "1032" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "edi" "cita" => "Rev Esp Med Nucl Imagen Mol. 2019;38:69-71" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4 "formatos" => array:2 [ "HTML" => 2 "PDF" => 2 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Editorial" "titulo" => "General Data Protection Regulation. 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López Buitrago, Juan M. Muñoz Acosta, Rodrigo A. Cárdenas-Perilla" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Diego F." "apellidos" => "López Buitrago" "email" => array:1 [ 0 => "dr.diegolopez10@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Juan M." "apellidos" => "Muñoz Acosta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Rodrigo A." "apellidos" => "Cárdenas-Perilla" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Orthodontics Graduate Program, Universidad del Valle, Cali, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Nuclear Medicine Department, Centro Médico Imbanaco, Cali, Colombia" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comparación de cuatro métodos de valoración cuantitativa del SPECT con 99mTc-MDP en pacientes con sospecha clínica de hiperplasia condilar" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1019 "Ancho" => 950 "Tamanyo" => 90581 ] ] "descripcion" => array:1 [ "en" => "ROI variable-size, one image: The image showing highest uptake was selected in both condyles. A variable-size ROI was manually outlined, including the total uptake area. Maximum counts, pixel number and average counts were obtained for that area." ] ] ] "textoCompleto" => "IntroductionCondylar hyperplasia (CH) is a pathology that affects facial esthetics, masticatory function, occlusal stability and temporomandibular joint health as a consequence of the progressive facial asymmetry due to overgrowth of one mandibular condyle.<a class="elsevierStyleCrossRefs" href="#bib0175">1,2</a> CH is a self-limiting condition related to unbalanced growth and causing facial deformations, more frequently before growth ends, but may be present after that.<a class="elsevierStyleCrossRefs" href="#bib0185">3,4</a>CH is frequently unilateral and more likely to occur in women than in men according to some reports.<a class="elsevierStyleCrossRefs" href="#bib0195">5,6</a> Its etiology is not definitely established but it has been related to genetic, traumatic, functional, tumor or hormonal factors.<a class="elsevierStyleCrossRefs" href="#bib0205">7,8</a> CH is classified in three categories: hemimandibular hyperplasia (HH) that is a vertical growth asymmetry, hemimandibular elongation (HE) that is a horizontal growth asymmetry, and a combination of the above two types.<a class="elsevierStyleCrossRefs" href="#bib0175">1,9</a>CH diagnostic is based on extraoral/intraoral clinical findings as well as radiographic/tomographic findings.<a class="elsevierStyleCrossRefs" href="#bib0185">3,10</a> Usually, this diagnosis is confirmed by referring the patient for a nuclear medicine test to determine if there is an increased osteoblast metabolic activity in one of the condyles, indicating that the pathology is active.<a class="elsevierStyleCrossRefs" href="#bib0225">11–16</a>Historically, the two most used nuclear medicine tests for CH are: planar bone scintigraphy and single photon emission computed tomography (SPECT). Both use 99mTc methylene-diphosphonate (MDP) as radioactive tracer. Many studies found that SPECT is more efficient than planar bone scintigraphy in detecting active CH.<a class="elsevierStyleCrossRefs" href="#bib0200">6,17–21</a> There is no standard technique for the quantitative evaluation of SPECT results to assess a difference between condylar uptake of the radiotracer 99mTc-MDP. It is remarkable that the decision to perform condylectomy is almost exclusively based on a SPECT positive diagnosis of CH, that is defined by a percentage of uptake by the affected condyle equal or higher than 10% of the uptake detected in the contralateral condyle.<a class="elsevierStyleCrossRefs" href="#bib0230">12,22–25</a> Therefore, it is very important to identify a method of quantitative evaluation and interpretation of the test that offers the best possible CH diagnostic precision and accuracy.Therefore, the objective of this study was to compare four quantitative techniques to interpret SPECT results in patients with clinically suspected CH active in terms of variability, reproducibility and repeatability. The four methods are based on the combination of condylar regions of interest (ROI) with a fixed-size of 1.76cm2 or variable-size ROI measured in either one or five images, measuring total counts or normalized counts.Material and methodsThe group of patients in the study included 21 women (55%) and 17 men (45%) with a range of age between 11 and 44 (average: 21 year), referred for a SPECT test by their treating specialist to the Nuclear Medicine Department, between 2015 and 2017 due to a preliminary clinical diagnosis of facial asymmetry and clinically and radiographic suspected UCH. Patients with a history of temporo-mandibular joint (TMJ) surgery, dentofacial syndromic anomalies, craniofacial trauma or present pregnancy were excluded.The study was approved by the Institutional Ethics Committee (Approval code CEI-293).Following the institutional protocol, all the SPECT images were obtained 2h after intravenous administration of 99mTc-MDP (555MBq in patients over 18 year and normalized according to the Pediatric Dosage Card in patients under 18 year). The images were obtained with a dual-head gamma-camera (GE Infina®) using low energy, high resolution planar collimators, a 128×128 matrix, and zoom 1.3. Over 360°, 45 images of 18s each were acquired for every 180°.The data were reconstructed in a process station Xeleris 3, with the program “Volumetrix MI Evolution for Bone”, under iterative reconstruction OSEM from 4 iterative steps and 8 subsets, applying a Butterworth 0.45 filter and power 12. From this reconstruction, trans-axial images were obtained to be used in the next four quantitative techniques: variable-size ROI 1 image, fixed-size ROI 1 image, variable-size ROI 5 image and fixed-size ROI 5 image, each section with a constant width: 4.4mm. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> and <a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–5</a> describe each technique of evaluation.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia>The area to be measured in the fixed- size ROIs was standardized by the processor as 1.76cm2 and for each technique, the maximum counts, number of pixels and normalized counts were extracted. Two nuclear medicine experts independently read twice all 38 reports. Additionally, 15 SPECT images were evaluated by the same observer 15 days after the first reading, to assess intra-observer reproducibility.From the total counts and normalized counts, according to the number of pixels, it was calculated the uptake for each condyle, using the following equations:<elsevierMultimedia ident="eq0005"></elsevierMultimedia><elsevierMultimedia ident="eq0010"></elsevierMultimedia>Normalized counts are the total counts obtained for the selected ROI divided by the number of pixels to provide a constant value for each pixel.Statistical analysisThe average and standard deviation was obtained for each measure. Normality of data distribution was evaluated by the Shapiro–Wilk test. The four techniques were compared by one-way ANOVA. Intra-observer repeatability was estimated by the intraclass correlation coefficient (ICC) and its 95% confidence interval (95% CI). Inter-observer reproducibility was estimated by Dahlberg coefficient and ICC. Bland–Altman graphs were also obtained to compare data variability. The diagnostic agreement for detection of uptake percentage condylar differences ≥10% was calculated as percentage and Kappa coefficient. The statistical analyses were carried out using the program Stata 13 (Stata Corp., College Station, TX, USA). The level of significance was 0.05.ResultsReproducibility (inter-operator variability)<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> summarizes the results for inter-operator differences. Taking into account the 95% CI value, the method of reading in 5 images a fixed ROI provides less variability between operators, followed by the method using 1 fixed image. The methods based on variable ROI had greater variability. There are no differences related to the mandibular deviation side. The Dahlberg S coefficient in fixed-size ROI, the method of reading in 5 images is almost equal using total counts (0.90) or normalized counts (0.88), but significantly lower than in variable-size ROIs, indicating better inter-operator reproducibility.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Repeatability (intra-operator variability)<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the Dahlberg S value and 95% CI for total and normalized counts for each condyle. The lowest Dahlberg S value (0.32) was obtained using the method of reading in 5 images a fixed ROI using total counts by both operators. The techniques based on reading a fixed ROI area of 1.76cm2 provided excellent repeatability (ICC>0.90), although readings from operator 2 were more variable.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Comparison of techniquesNo significant differences were detected in the percentage of uptake measured by any method when sides were compared (right vs left), or when the results from total counts were compared to normalized counts (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>) (p>0.05).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>Regarding the variability of the method, the lowest standard deviation, and therefore the lowest variance was obtained in the method using 1 image, variable-size ROI method, with normalized values (SD: 3.9) followed by the method using 5 images, fixed-size ROI, normalized values (SD: 5.5).The number of SPECT positive cases (uptake difference between sides ≥10%, indicative of unilateral active growth) detected was higher when total counts were used, compared to normalized counts, particularly in variable-size ROI techniques. The agreement between results based on total counts vs normalized counts was higher in fixed-size ROI techniques than in variable-size techniques (97.4% of agreement, Kappa>0.94) (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>).<elsevierMultimedia ident="tbl0025"></elsevierMultimedia>The number of SPECT positive cases, was also compared among methods. The method using 1 image, variable-size ROI total counts, detected the highest number of positive cases (n=27). When normalized values were used in this technique, only n=5 cases were identified as positive. This tendency was also observed in the method using 5 images, variable method. In the method using 1 image fixed-size ROI, there is no difference between total and normalized counts, concerning this apparent diagnostic sensitivity (kappa and p value presented in <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>).The diagnostic agreement compared between pairs of methods indicates higher concordance in fixed-size ROI techniques when 1 image is compared to 5 images (92.1% of agreement). On the other hand, the agreement is poor when variable-size ROI techniques were compared (<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>). In general, agreement between techniques is better when normalized counts are used.<elsevierMultimedia ident="tbl0030"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a> illustrates the comparative variability between fixed and variable ROI methods. The method of 1 image variable ROI apparently tends to overestimate the percentage of uptake, specifically when total counts per condyle are higher than 20%. Limits of agreement (LA)=−7.91; [−3.27 to 16.9]. On the other hand, the results for the fixed ROI methods reported an LA=−1.04; [−8.97 to 6.88] what might suggest that both methods could be clinically equivalent as the points oscillate around 0 and the LA falls within the clinically acceptable range.<elsevierMultimedia ident="fig0030"></elsevierMultimedia>DiscussionThe first report of planar bone gammagraphy in 21 patients with facial asymmetry was published by Cisneros in 1984.<a class="elsevierStyleCrossRef" href="#bib0225">11</a> Posteriorly Israel et al. in 1988<a class="elsevierStyleCrossRef" href="#bib0300">26</a> and Front et al. in 1989<a class="elsevierStyleCrossRef" href="#bib0305">27</a>, studied the ability of SPECT to detect deep bone lesions that planar image methods could not detect. Saridin et al. in 2008<a class="elsevierStyleCrossRef" href="#bib0260">18</a> compared the two kinds of gammagraphic tests in 56 patients with suspected UCH. They found more sensitivity (93%) and specificity (96%) for SPECT compared to planar bone scintigraphy, concluding that SPECT is more reliable as a diagnostic tool identifying the radiotracer uptake in each condyle. More recently, López and Corral in 2016<a class="elsevierStyleCrossRef" href="#bib0200">6</a> published their study of 61 patients, that shows as well that SPECT is superior to planar image to identify condylar uptake of the radionuclide (32 positive results detected by SPECT (52.46%) against 8 (13.1%) detected by planar scintigraphy). The meta-analysis published by Saridin et al. in 2011<a class="elsevierStyleCrossRef" href="#bib0265">19</a> reports better sensitivity and specificity for SPECT (90–95%) compared to planar scintigraphy (71–92%).Additionally Wen et al. in 2014<a class="elsevierStyleCrossRef" href="#bib0310">28</a> evaluated the diagnostic value of 99mTc-MDP SPECT in patients with clinically suspected CH, based on the higher condylar activity in the affected side (59%) against the contralateral (41%), expressed by a differential uptake of the radionuclide. This report is in agreement with Hooder et al. (2000),<a class="elsevierStyleCrossRef" href="#bib0290">24</a> Kajan et al. (2006)<a class="elsevierStyleCrossRef" href="#bib0295">25</a> and Fahey et al. (2009)<a class="elsevierStyleCrossRef" href="#bib0280">22</a> and reports that differences of more than 10% between condyles is indicative of UCH. Considering the above summarized findings, different therapeutic algorithms have been suggested by Hooder et al. in 2000<a class="elsevierStyleCrossRef" href="#bib0290">24</a> and Rushinek et al. in 2016.<a class="elsevierStyleCrossRef" href="#bib0315">29</a> The surgical approach, condylectomy of the affected side, is suggested when the difference between condylar uptake of 99mTc-MDP is more than 10%. The results of the present study show a dramatic change in the number of positive cases, when fixed ROI are compared to variable ROI and when total counts are compared to normalized counts in variable ROIs as well. This may be related to the fact that variable ROIs detect the total condylar uptake that is related to the grade of activity in the ossification nucleus and/or to condylar size. On the other hand, a fixed ROI detects uptake in the area considered for both condyles. Hence, the method applied may significantly alter the therapeutic surgical decision.López et al. in 2017<a class="elsevierStyleCrossRef" href="#bib0320">30</a> analyzed 51 SPECT images from patients with facial asymmetry and compared the value of qualitative reports, based upon the subjective interpretation of a nuclear medicine expert, versus quantitative reports obtained measuring radionuclide uptake in a region of interest (ROI) of each condyle. The conclusion was that qualitative reports are less reliable than quantitative data (percentage of agreement: 39.2%). The authors considered that the main limitation of quantitative reports is their inability to detect bilateral CH cases, because the diagnosis is based on a 10% difference between both sides in condylar uptake.Therefore, it is generally accepted that SPECT quantitative results are the best option available to detect hyperactivity in a condylar tissue. But there is no consensus about the standardization of SPECT quantitative protocols, to select the more reliable technical approach, in terms of reproducibility and variability. Pripatnanont et al., 2005<a class="elsevierStyleCrossRef" href="#bib0255">17</a> studied 29 UCH patients to determine the finalization of mandibular growth, using three methods for quantitative interpretation of SPECT results. From a ROI located in the head of the condyle, they measured the total radioactive counts, the number of pixels and the normalized counts per pixel. They concluded that the total counts are sufficient to establish the percentage of uptake in each condyle and distinguish active/passive condylar growth stages.Fahey et al., <a class="elsevierStyleCrossRef" href="#bib0280">22</a> evaluated radionuclide uptake in healthy subjects with no symptoms of CH, using two techniques to interpret the data; the first technique measured counts in a fixed-size ROI of 1.13cm2, considering the maximum values and the second technique measured activity in fixed ROIs obtaining the average of total counts in three transaxial sections. Alsharif et al., <a class="elsevierStyleCrossRef" href="#bib0180">2</a> evaluated the diagnostic value of three quantitative techniques for SPECT interpretation in 33 patients with CH: the first technique used a whole condyle approach, measuring a variable ROI equal to the total volume of each condyle; the second technique measured total counts in a fixed-size ROI (1.14cm2) drawn at the center of each condyle, on a single transaxial image; the third technique considered a fixed-size ROI (1.14cm2), but on five transaxial images. They concluded that fixed-size ROI maximum counts and the percentage difference in condylar activity of 10% as a cut-off provide the best combination of sensitivity, specificity, positive and negative predictive values. Similar findings were obtained in the present study as no significant differences in the number of positive cases were detected using total counts vs normalized counts in fixed-size ROIs.Additionally, Rushinek et al.<a class="elsevierStyleCrossRef" href="#bib0315">29</a> evaluated three approaches to SPECT analysis for the diagnostic of UCH, in terms of sensitivity and specificity: fixed-size ROI, average volume of interest (VOI), and maximum VOI. The specificity of these three approaches was respectively: 77%, 65%, and 70% with the same sensitivity (88%) for all of them.All the above-mentioned investigations coincide with the present study about the advantage of fixed-size ROIs compared to variable ROIs. In the present study, the agreement between total and normalized counts is high for fixed-size ROIs (97.4% of agreement, Kappa 0.940 and p 0.000). The diagnostic agreement between paired techniques is also favorable to fixed-size ROIs (92.1% of agreement, Kappa 0.820 and p 0.000), but the difference between using 1 or 5 images is not relevant.However, Kim et al., <a class="elsevierStyleCrossRef" href="#bib0325">31</a> and Velásquez et al., <a class="elsevierStyleCrossRef" href="#bib0330">32</a> provided evidence of anatomic differences between the deviated side and the contralateral side in patients with facial asymmetry. As these differences affect the condylar shape, articular eminence height and the projection of condyle within the articular fossa, the use of only one transaxial slice might not be as representative as the summatory of a few transaxial tomographic slices, to detect uptake differences between condyles. Therefore, anatomic differences should be considered in patients with facial asymmetry when the SPECT is used and interpreted.According to the results obtained by Alsharif et al.,<a class="elsevierStyleCrossRef" href="#bib0180">2</a> the technique using variable ROI and one image with normalized values presents the lowest variability, as in the present study, and provides 88% of sensitivity and 87.5% specificity. But when the variable-size ROI is applied to the total volume of condylar head, the high sensitivity and specificity may depend on the variability in size of the condyle. Lin et al.,<a class="elsevierStyleCrossRef" href="#bib0335">33</a> in a 3D evaluation of the condyle in patients with mandibular asymmetry reported that in fact the condylar size was increased in the asymmetric side. Therefore, the uptake of radionuclide may be influenced by the condylar size, but as well may be due to the activity in the growth nucleus, articular incongruence and the zone of photon scattering within the tissues. In condyles of higher size, the likelihood of false positive diagnostics could be increased.Regarding intra-operator and inter-operator reproducibility, the technique offering best reproducibility was the 5 image fixed-size ROI, followed by the 1 image fixed-size ROI. This finding is concordant with the study of Karssemakers et al.,<a class="elsevierStyleCrossRef" href="#bib0340">34</a> that in 67 SPECT images demonstrated a strong correlation between operators and a 100% of agreement when total counts were used. But in that study intra-operator repeatability was not measured and different quantitative techniques were not compared as in the present study.In variable-size ROI data, the diagnostic difference obtained is notorious when total counts vs normalized counts are used. Altogether, our results suggest that the best technical option is the use of 5 image, fixed-size ROI total counts when SPECT is applied for the diagnostic of UCH.Using 5 images instead of only one, as is common in previous studies, is justified by the likelihood that the selected image may not be representative of the pathology. In SPECT images, reorientation of the volumetric image before selection of the slice is a critical issue. The use of 5 images reduces errors related to a wrong selection of the area or its reorientation. On the other hand, variable ROIs are more dependent on the operator selection and interpretation, and therefore tend to be more variable than fixed-size ROIs.Finally, the use of normalized counts, assigning a constant value for each pixel within each ROI, avoids the bias of selection when the area of highest uptake is selected. However, the use of normalized counts underestimates the zone of highest uptake because it redistributes the counts in pixels of less uptake and its value is not well defined because there are established normal values. On the other hand, the use of maximum total counts is less variable and more reproducible than normal counts, but its high sensibility may cause more false positive results. For this reason, it is important that the diagnosis of CH should be made from an adequate correlation between facial and intraoral clinical characteristics with radiographic and/or tomographic findings. Being SPECT the only test providing information about the cellular metabolic activity of the suspected condyle, in order to distinguish between an active or passive CH and/or another entity.A limitation of the present study, common to almost all the previous studies, is that it does not provide data to correlate the condylar metabolic activity with morphologic condylar changes, in order to improve specificity. Another limitation is that real values of sensitivity and specificity could not be supported by histologic post-surgical data. In similar studies sensitivity, specificity and predictive values were obtained by clinical follow-up of the patients, in absence of a histopathological gold standard.<a class="elsevierStyleCrossRef" href="#bib0180">2</a>On the other hand, it is well established that increasing sensitivity, the specificity is reduced. Therefore, it is necessary to accept an intermediate compromise between the likelihood of obtaining false positive results and false negative results, in a situation when both may have deleterious effects. In this study the use of normalized counts detected less cases considered as positive for CH but total counts detected more positive cases.The correct quantitative assessment of the SPECT test will allow the development of studies related not only to the percentage of absorption between condyles, but also with the absorption ratio in order to identify bilateral cases.ConclusionsThe comparison of four techniques to interpret SPECT results for the diagnostic of UCH suggests that the more reliable option is to use the method of 5 trans-axial slices, fixed-size ROI and total counts.Funding sourcesThis research did not receive any specific grant from funding agencies in the public, commercial, or non-profit sectors.Conflict of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1157585" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1084739" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1157584" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1084740" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0020" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Reproducibility (inter-operator variability)" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Repeatability (intra-operator variability)" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Comparison of techniques" ] ] ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Funding sources" ] 10 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of interest" ] 11 => array:2 [ "identificador" => "xack394968" "titulo" => "Acknowledgment" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-06-12" "fechaAceptado" => "2018-07-23" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1084739" "palabras" => array:4 [ 0 => "Condylar hyperplasia" 1 => "Facial asymmetry" 2 => "99mTc-MDP" 3 => "Bone SPECT" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1084740" "palabras" => array:4 [ 0 => "Hiperplasia condilar" 1 => "Asimetría facial" 2 => "99mTc-MDP" 3 => "SPECT óseo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo compare variability, reproducibility and repeatability of four quantitative evaluation methods to interpret the 99mTc-MDP SPECT reports in patients with clinically suspected unilateral condylar hyperplasia (UCH). MethodThis was a descriptive observational study carried out with SPECT images of 38 patients with clinical and radiographic signs of UCH, and interpreted using four quantitative methods: (1) one image, variable-size region of interest (ROI); (2) one image, fixed-size ROI (1.76cm2), (3) five image variable-size ROI; (4) five image, fixed-size ROI (1.76cm2). Each of the images were report simultaneously but in an independent way by the two nuclear medicine experts in both total radioactive counts as well as normalized counts to quantify the reproducibility (inter-operator variability) and the repeatability (intra-operator variability). ResultsHigher reproducibility and repeatability were obtained in 5-image fixed-size ROI method (intra-class correlation coefficient: 0.979 [0.959; 0.989]). A high grade of diagnostic agreement (97.4%) was also attained in fixed methods (Kappa 0.940, p value: 0.000) from either total or normalized counts. There was no difference between fixed-size 1 vs 5 image methods. The methods based on variable-size ROI had a low grade of agreement (Kappa<0.20). More positive cases were identified using one image, ROI variable total counts (27 cases), but when the counts were normalized, they presented a lower number (5 cases). ConclusionFive-image fixed-size ROI provides the best intra-operator and inter-operator reliability for the diagnosis of unilateral condylar hyperplasia. In the four methods using normalized counts fewer positive cases were detected (≥10%), unlike with total counts when more positive cases were found." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoComparar la variabilidad, reproducibilidad y repetitividad de cuatro métodos de evaluación cuantitativa del SPECT con 99mTc-MDP en pacientes con sospecha clínica de hiperplasia condilar unilateral (HCU). MétodosEstudio observacional descriptivo, realizado en 38 imágenes SPECT de pacientes con signos clínicos y radiográficos de HCU. Estos fueron interpretados utilizando cuatro métodos cuantitativos de la prueba SPECT: (1) Región objeto de interés (ROI) variable de 1 imagen, (2) ROI fija de 1,76cm2 en 1 imagen, (3) ROI variable de 5 imágenes y (4) ROI fija de 1,76cm2 en 5 imágenes. Cada una de las imágenes fue leída simultáneamente de forma independiente por dos médicos nucleares tanto en sus cuentas totales como en las cuentas normalizadas para cuantificar la reproducibilidad (variabilidad inter-observador) de los métodos y la repetitividad (variabilidad intra-observador). ResultadosMayor reproducibilidad y repetitividad fue obtenida con el método de ROI fija de 1.76cm2 en 5 imágenes (coeficiente de correlación intra-clase de 0,979 [0,959; 0,989]). De igual forma se obtuvo un mayor grado de correspondencia diagnóstica (97,4%) en los métodos fijos (Kappa 0,940, valor p: 0.000) tanto en cuentas totales como normalizadas. No se encontraron diferencias entre ellos. Los métodos basados en el análisis de ROIs variables presentaron un menor grado de correspondencia (Kappa<0,20). El mayor número de casos positivos fue identificado utilizando una ROI variable de 1 imagen en cuentas totales (27 casos), pero al normalizar las cuentas presentaron el menor número (5 casos). ConclusionesDe acuerdo a la variación intra e interoperadores, la técnica de mejor repetitividad y reproducibilidad para el diagnóstico de la hiperplasia condilar unilateral fue la ROI fija de 5 imágenes. En los cuatro métodos, al usar cuentas normalizadas, se detectaron menos casos positivos (≥10%) y con cuentas totales mas casos positivos." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: López Buitrago DF, Muñoz Acosta JM, Cárdenas Perilla RA. Comparación de cuatro métodos de valoración cuantitativa de 99mTC-MDP SPECT en pacientes con sospecha clínica de hiperplasia condilar. Rev Esp Med Nucl Imagen Mol. 2019;38:72–79." ] ] "multimedia" => array:14 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1019 "Ancho" => 950 "Tamanyo" => 90581 ] ] "descripcion" => array:1 [ "en" => "ROI variable-size, one image: The image showing highest uptake was selected in both condyles. A variable-size ROI was manually outlined, including the total uptake area. Maximum counts, pixel number and average counts were obtained for that area." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1569 "Ancho" => 1583 "Tamanyo" => 174486 ] ] "descripcion" => array:1 [ "en" => "Fixed size ROI one image: The more active image was selected in each condyle and a fixed-size (1.76cm2) ROI was outlined on each condyle head to obtain maximum counts, pixel number and average counts." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 865 "Ancho" => 1250 "Tamanyo" => 81188 ] ] "descripcion" => array:1 [ "en" => "(A) The five transaxial slices with the highest condylar activity. (B) The summed image of the five transaxial slices." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 897 "Ancho" => 950 "Tamanyo" => 62776 ] ] "descripcion" => array:1 [ "en" => "Variable-size ROI image obtained from 5 trans-axial slices visualizing the condyles." ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 891 "Ancho" => 950 "Tamanyo" => 63708 ] ] "descripcion" => array:1 [ "en" => "Fixed-size (1.76cm2) ROI image from 5 trans-axial slices visualizing the condyles." ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Fig. 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 783 "Ancho" => 2323 "Tamanyo" => 118501 ] ] "descripcion" => array:1 [ "en" => "Bland–Altman graphs showing average differences and dispersion in the uptake percentage. (A) Differences between variable-size ROI from using 5-images and 1-image methods. (B) Differences between fixed-size ROI from using 5-images and 1-image methods." ] ] 6 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Technique \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Definition \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Variable-size ROI 1 image \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">In a single transaxial slice with the highest condylar activity, a variable-size ROI for each condyle keeping the trace of the contour to include total uptake was manually drawn (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fixed-size ROI 1 image \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">In a single transaxial slice with the highest condylar activity, a fixed-size ROI (1.76cm2) on each condylar head was positioned (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Variable-size ROI 5 image \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">In a image obtain by the summed of five transaxial slices, a variable-size ROI for each condyle keeping the trace of the contour to include total uptake was manually draw. (<a class="elsevierStyleCrossRefs" href="#fig0015">Figs. 3 and 4</a>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fixed-size ROI 5 image \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">In a image obtain by the summed of five transaxial slices with the highest condylar activity, a fixed-size ROI (1.76cm2) on each condylar head was positioned. (<a class="elsevierStyleCrossRefs" href="#fig0015">Figs. 3 and 5</a>) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1976503.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Definition of quantitative techniques." ] ] 7 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Technique</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Total counts</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Normalized counts/pixels</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Right condyle \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Left condyle \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Right condyle \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Left condyle \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Variable-size ROI 1 image</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dahlberg S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.07 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">[95% CI] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.880 [0.959; 0.989] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.880 [0.778; 0.937] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.884 [0.788; 0.938] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.884 [0.788; 0.938] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Fixed-size ROI 1 image</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dahlberg S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.50 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">[95% CI] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.856 [0.738; 0.923] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.891 [0.797; 0.942] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.891 [0.797; 0.943] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.891 [0.797; 0.943] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Variable-size ROI 5 image</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dahlberg S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">[95% CI] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.810 [0.661; 0.898] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.810 [0.661; 0.898] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.837 [0.703; 0.913] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.837 [0.703; 0.913] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Fixed-size ROI 5 image</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dahlberg S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.88 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">[95% CI] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.979 [0.959; 0.989] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.979 [0.959; 0.989] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.975 [0.953; 0.987] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.975 [0.953; 0.987] \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1976505.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Inter-operator reproducibility using total and normalized counts for each condyle." ] ] 8 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Technique</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Total counts – right condyle</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Normalized counts/pixel – left condyle</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Operator 1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Operator 2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Operator 1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Operator 2 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Variable-size ROI 1 image</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dahlberg S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.77 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">[95% CI] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.899 [0.728; 0.965] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.859 [0.627; 0.952] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.892 [0.717; 0.962] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.814 [0.517; 0.936] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Fixed-size ROI 1 image</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dahlberg S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.58 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">[95% CI] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.984 [0.944; 0.995] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.929 [0.713; 0.979] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.982 [0.949; 0.994] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.899 [0.723; 0.966] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Variable-size ROI 5 image</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dahlberg S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.91 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">[95% CI] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.957 [0.872; 0.986] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.666 [0.247; 0.878] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.903 [0.741; 0.966] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.832 [0.582; 0.939] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Fixed-size ROI 5 image</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dahlberg S \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.52 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">[95% CI] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.991 [0.945; 0.994] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.998 [0.994; 0.999] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.982 [0.945; 0.994] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.999 [0.996; 0.999] \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1976502.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Repeatability (intra-operator reproducibility) using total and normalized counts." ] ] 9 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Technique</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Total counts</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Normalized counts/pixel</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Right condyle \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Left condyle \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Right condyle \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Left condyle \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Variable-size ROI 1 image</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Average±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50.5±14.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49.5±14.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49.5±3.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50.5±3.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">95% CI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.26 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Fixed-size ROI 1 image</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Average±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49.3±6.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50.7±6.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49.3±6.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50.7±6.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">95% CI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Variable-size ROI 5 image</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Average±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49.9±8.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50.1±8.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">51.3±7.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48.7±7.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">95% CI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.49 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Fixed-size ROI 5 image</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Average±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49.0±6.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">51.0±6.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49.2±5.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50.8±5.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">95% CI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.77 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1976500.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Uptake percentage using total and normalized counts." ] ] 10 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Technique \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total counts \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Normalized counts/pixel \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% of agreement \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Kappa (p value) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Variable-size ROI 5 image \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.201 (0.044) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fixed-size ROI 5 image \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.940 (0.000) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Variable-size ROI 1 image \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.116 (0.062) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fixed-size ROI 1 image \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.943 (0.000) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1976501.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Agreement of positive cases between total and normalized counts within each technique." ] ] 11 => array:8 [ "identificador" => "tbl0030" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at6" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Techniques compared \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% of agreement \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Kappa (p value) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="6" align="left" valign="top">Total counts</td><td class="td" title="table-entry " align="left" valign="top">Variable ROI 5 image vs fixed ROI 5 image \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.593 [0.409; 0.777] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.129 (0.208) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Variable ROI 5 image vs variable ROI 1 image \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.301 [0.077; 0.524] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.395 (0.002) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Variable ROI 5 image vs fixed ROI 1 image \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.535 [0.314; 0.757] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.079 (0.309) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fixed ROI 5 image vs variable ROI 1 image \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.277 [0.120; 0.434] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.349 (0.002) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fixed ROI 5 image vs fixed ROI 1 image \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.889 [0.825; 0.954] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.828 (0.000) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Variable ROI 1 image vs fixed ROI 1 image \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.307 [0.129; 0.486] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.289 (0.012) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="6" align="left" valign="top">Normalized counts/pixel</td><td class="td" title="table-entry " align="left" valign="top">Variable ROI 5 image vs fixed ROI 5 image \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.300 [0.064; 0.536] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.494 (0.000) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Variable ROI 5 image vs variable ROI 1 image \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.142 [−0.082; 0.367] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.539 (0.000) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Variable ROI 5 image vs fixed ROI 1 image \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.282 [0.020; 0.545] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.451 (0.000) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fixed ROI 5 image vs variable ROI 1 image \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.729 [0.597; 0.861] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.349 (0.006) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fixed ROI 5 image vs fixed ROI 1 image \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.916 [0.868; 0.965] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.821 (0.000) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Variable ROI 1 image vs fixed ROI 1 image \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.724 [0.606; 0.841] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.451 (0.000) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1976504.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Diagnostic agreement between pairs of techniques." ] ] 12 => array:5 [ "identificador" => "eq0005" "tipo" => "MULTIMEDIAFORMULA" "mostrarFloat" => false "mostrarDisplay" => true "Formula" => array:5 [ "Matematica" => "Number of normalized counts=Condyle countsNumber of pixels" "Fichero" => "STRIPIN_si1.jpeg" "Tamanyo" => 4198 "Alto" => 35 "Ancho" => 351 ] ] 13 => array:5 [ "identificador" => "eq0010" "tipo" => "MULTIMEDIAFORMULA" "mostrarFloat" => false "mostrarDisplay" => true "Formula" => array:5 [ "Matematica" => "% condylar uptake=Condyle countsCondyle counts+Contralateral condyle counts∗100%" "Fichero" => "STRIPIN_si2.jpeg" "Tamanyo" => 6590 "Alto" => 61 "Ancho" => 396 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:34 [ 0 => array:3 [ "identificador" => "bib0175" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemimandibular hyperplasia – hemimandibular elongation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H.L. 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Comparison of four methods for quantitative assessment of 99mTc-MDP SPECT in patients with suspected condylar hyperplasia

Comparación de cuatro métodos de valoración cuantitativa del SPECT con 99mTc-MDP en pacientes con sospecha clínica de hiperplasia condilar

Diego F. López Buitragoa,

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dr.diegolopez10@gmail.com

Corresponding author.

, Juan M. Muñoz Acostab, Rodrigo A. Cárdenas-Perillab

a Orthodontics Graduate Program, Universidad del Valle, Cali, Colombia

b Nuclear Medicine Department, Centro Médico Imbanaco, Cali, Colombia

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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">ROI variable-size&#44; one image&#58; The image showing highest uptake was selected in both condyles&#46; A variable-size ROI was manually outlined&#44; including the total uptake area&#46; Maximum counts&#44; pixel number and average counts were obtained for that area&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Condylar hyperplasia &#40;CH&#41; is a pathology that affects facial esthetics&#44; masticatory function&#44; occlusal stability and temporomandibular joint health as a consequence of the progressive facial asymmetry due to overgrowth of one mandibular condyle&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">1&#44;2</span></a> CH is a self-limiting condition related to unbalanced growth and causing facial deformations&#44; more frequently before growth ends&#44; but may be present after that&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">CH is frequently unilateral and more likely to occur in women than in men according to some reports&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">5&#44;6</span></a> Its etiology is not definitely established but it has been related to genetic&#44; traumatic&#44; functional&#44; tumor or hormonal factors&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">7&#44;8</span></a> CH is classified in three categories&#58; hemimandibular hyperplasia &#40;HH&#41; that is a vertical growth asymmetry&#44; hemimandibular elongation &#40;HE&#41; that is a horizontal growth asymmetry&#44; and a combination of the above two types&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">1&#44;9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">CH diagnostic is based on extraoral&#47;intraoral clinical findings as well as radiographic&#47;tomographic findings&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">3&#44;10</span></a> Usually&#44; this diagnosis is confirmed by referring the patient for a nuclear medicine test to determine if there is an increased osteoblast metabolic activity in one of the condyles&#44; indicating that the pathology is active&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">11&#8211;16</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Historically&#44; the two most used nuclear medicine tests for CH are&#58; planar bone scintigraphy and single photon emission computed tomography &#40;SPECT&#41;&#46; Both use <span class="elsevierStyleSup">99m</span>Tc methylene-diphosphonate &#40;MDP&#41; as radioactive tracer&#46; Many studies found that SPECT is more efficient than planar bone scintigraphy in detecting active CH&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">6&#44;17&#8211;21</span></a> There is no standard technique for the quantitative evaluation of SPECT results to assess a difference between condylar uptake of the radiotracer <span class="elsevierStyleSup">99m</span>Tc-MDP&#46; It is remarkable that the decision to perform condylectomy is almost exclusively based on a SPECT positive diagnosis of CH&#44; that is defined by a percentage of uptake by the affected condyle equal or higher than 10&#37; of the uptake detected in the contralateral condyle&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">12&#44;22&#8211;25</span></a> Therefore&#44; it is very important to identify a method of quantitative evaluation and interpretation of the test that offers the best possible CH diagnostic precision and accuracy&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Therefore&#44; the objective of this study was to compare four quantitative techniques to interpret SPECT results in patients with clinically suspected CH active in terms of variability&#44; reproducibility and repeatability&#46; The four methods are based on the combination of condylar regions of interest &#40;ROI&#41; with a fixed-size of 1&#46;76<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span> or variable-size ROI measured in either one or five images&#44; measuring total counts or normalized counts&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">The group of patients in the study included 21 women &#40;55&#37;&#41; and 17 men &#40;45&#37;&#41; with a range of age between 11 and 44 &#40;average&#58; 21 year&#41;&#44; referred for a SPECT test by their treating specialist to the Nuclear Medicine Department&#44; between 2015 and 2017 due to a preliminary clinical diagnosis of facial asymmetry and clinically and radiographic suspected UCH&#46; Patients with a history of temporo-mandibular joint &#40;TMJ&#41; surgery&#44; dentofacial syndromic anomalies&#44; craniofacial trauma or present pregnancy were excluded&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The study was approved by the Institutional Ethics Committee &#40;Approval code CEI-293&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Following the institutional protocol&#44; all the SPECT images were obtained 2<span class="elsevierStyleHsp" style=""></span>h after intravenous administration of <span class="elsevierStyleSup">99m</span>Tc-MDP &#40;555<span class="elsevierStyleHsp" style=""></span>MBq in patients over 18 year and normalized according to the Pediatric Dosage Card in patients under 18 year&#41;&#46; The images were obtained with a dual-head gamma-camera &#40;GE Infina<span class="elsevierStyleSup">&#174;</span>&#41; using low energy&#44; high resolution planar collimators&#44; a 128<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>128 matrix&#44; and zoom 1&#46;3&#46; Over 360&#176;&#44; 45 images of 18<span class="elsevierStyleHsp" style=""></span>s each were acquired for every 180&#176;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The data were reconstructed in a process station Xeleris 3&#44; with the program &#8220;Volumetrix MI Evolution for Bone&#8221;&#44; under iterative reconstruction OSEM from 4 iterative steps and 8 subsets&#44; applying a Butterworth 0&#46;45 filter and power 12&#46; From this reconstruction&#44; trans-axial images were obtained to be used in the next four quantitative techniques&#58; variable-size ROI 1 image&#44; fixed-size ROI 1 image&#44; variable-size ROI 5 image and fixed-size ROI 5 image&#44; each section with a constant width&#58; 4&#46;4<span class="elsevierStyleHsp" style=""></span>mm&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> and <a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1&#8211;5</a> describe each technique of evaluation&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The area to be measured in the fixed- size ROIs was standardized by the processor as 1&#46;76<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span> and for each technique&#44; the maximum counts&#44; number of pixels and normalized counts were extracted&#46; Two nuclear medicine experts independently read twice all 38 reports&#46; Additionally&#44; 15 SPECT images were evaluated by the same observer 15 days after the first reading&#44; to assess intra-observer reproducibility&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">From the total counts and normalized counts&#44; according to the number of pixels&#44; it was calculated the uptake for each condyle&#44; using the following equations&#58;<elsevierMultimedia ident="eq0005"></elsevierMultimedia><elsevierMultimedia ident="eq0010"></elsevierMultimedia></p><p id="par0060" class="elsevierStylePara elsevierViewall">Normalized counts are the total counts obtained for the selected ROI divided by the number of pixels to provide a constant value for each pixel&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">The average and standard deviation was obtained for each measure&#46; Normality of data distribution was evaluated by the Shapiro&#8211;Wilk test&#46; The four techniques were compared by one-way ANOVA&#46; Intra-observer repeatability was estimated by the intraclass correlation coefficient &#40;ICC&#41; and its 95&#37; confidence interval &#40;95&#37; CI&#41;&#46; Inter-observer reproducibility was estimated by Dahlberg coefficient and ICC&#46; Bland&#8211;Altman graphs were also obtained to compare data variability&#46; The diagnostic agreement for detection of uptake percentage condylar differences &#8805;10&#37; was calculated as percentage and Kappa coefficient&#46; The statistical analyses were carried out using the program Stata 13 &#40;Stata Corp&#46;&#44; College Station&#44; TX&#44; USA&#41;&#46; The level of significance was 0&#46;05&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Reproducibility &#40;inter-operator variability&#41;</span><p id="par0070" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> summarizes the results for inter-operator differences&#46; Taking into account the 95&#37; CI value&#44; the method of reading in 5 images a fixed ROI provides less variability between operators&#44; followed by the method using 1 fixed image&#46; The methods based on variable ROI had greater variability&#46; There are no differences related to the mandibular deviation side&#46; The Dahlberg <span class="elsevierStyleItalic">S</span> coefficient in fixed-size ROI&#44; the method of reading in 5 images is almost equal using total counts &#40;0&#46;90&#41; or normalized counts &#40;0&#46;88&#41;&#44; but significantly lower than in variable-size ROIs&#44; indicating better inter-operator reproducibility&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Repeatability &#40;intra-operator variability&#41;</span><p id="par0075" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the Dahlberg <span class="elsevierStyleItalic">S</span> value and 95&#37; CI for total and normalized counts for each condyle&#46; The lowest Dahlberg <span class="elsevierStyleItalic">S</span> value &#40;0&#46;32&#41; was obtained using the method of reading in 5 images a fixed ROI using total counts by both operators&#46; The techniques based on reading a fixed ROI area of 1&#46;76<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span> provided excellent repeatability &#40;ICC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;90&#41;&#44; although readings from operator 2 were more variable&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Comparison of techniques</span><p id="par0080" class="elsevierStylePara elsevierViewall">No significant differences were detected in the percentage of uptake measured by any method when sides were compared &#40;right vs left&#41;&#44; or when the results from total counts were compared to normalized counts &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Regarding the variability of the method&#44; the lowest standard deviation&#44; and therefore the lowest variance was obtained in the method using 1 image&#44; variable-size ROI method&#44; with normalized values &#40;SD&#58; 3&#46;9&#41; followed by the method using 5 images&#44; fixed-size ROI&#44; normalized values &#40;SD&#58; 5&#46;5&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The number of SPECT positive cases &#40;uptake difference between sides &#8805;10&#37;&#44; indicative of unilateral active growth&#41; detected was higher when total counts were used&#44; compared to normalized counts&#44; particularly in variable-size ROI techniques&#46; The agreement between results based on total counts vs normalized counts was higher in fixed-size ROI techniques than in variable-size techniques &#40;97&#46;4&#37; of agreement&#44; Kappa<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;94&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">The number of SPECT positive cases&#44; was also compared among methods&#46; The method using 1 image&#44; variable-size ROI total counts&#44; detected the highest number of positive cases &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27&#41;&#46; When normalized values were used in this technique&#44; only <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5 cases were identified as positive&#46; This tendency was also observed in the method using 5 images&#44; variable method&#46; In the method using 1 image fixed-size ROI&#44; there is no difference between total and normalized counts&#44; concerning this apparent diagnostic sensitivity &#40;kappa and <span class="elsevierStyleItalic">p</span> value presented in <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The diagnostic agreement compared between pairs of methods indicates higher concordance in fixed-size ROI techniques when 1 image is compared to 5 images &#40;92&#46;1&#37; of agreement&#41;&#46; On the other hand&#44; the agreement is poor when variable-size ROI techniques were compared &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#41;&#46; In general&#44; agreement between techniques is better when normalized counts are used&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 6</a> illustrates the comparative variability between fixed and variable ROI methods&#46; The method of 1 image variable ROI apparently tends to overestimate the percentage of uptake&#44; specifically when total counts per condyle are higher than 20&#37;&#46; Limits of agreement &#40;LA&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;7&#46;91&#59; &#91;&#8722;3&#46;27 to 16&#46;9&#93;&#46; On the other hand&#44; the results for the fixed ROI methods reported an LA<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;1&#46;04&#59; &#91;&#8722;8&#46;97 to 6&#46;88&#93; what might suggest that both methods could be clinically equivalent as the points oscillate around 0 and the LA falls within the clinically acceptable range&#46;</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">The first report of planar bone gammagraphy in 21 patients with facial asymmetry was published by Cisneros in 1984&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">11</span></a> Posteriorly Israel et al&#46; in 1988<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">26</span></a> and Front et al&#46; in 1989<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">27</span></a>&#44; studied the ability of SPECT to detect deep bone lesions that planar image methods could not detect&#46; Saridin et al&#46; in 2008<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">18</span></a> compared the two kinds of gammagraphic tests in 56 patients with suspected UCH&#46; They found more sensitivity &#40;93&#37;&#41; and specificity &#40;96&#37;&#41; for SPECT compared to planar bone scintigraphy&#44; concluding that SPECT is more reliable as a diagnostic tool identifying the radiotracer uptake in each condyle&#46; More recently&#44; L&#243;pez and Corral in 2016<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">6</span></a> published their study of 61 patients&#44; that shows as well that SPECT is superior to planar image to identify condylar uptake of the radionuclide &#40;32 positive results detected by SPECT &#40;52&#46;46&#37;&#41; against 8 &#40;13&#46;1&#37;&#41; detected by planar scintigraphy&#41;&#46; The meta-analysis published by Saridin et al&#46; in 2011<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">19</span></a> reports better sensitivity and specificity for SPECT &#40;90&#8211;95&#37;&#41; compared to planar scintigraphy &#40;71&#8211;92&#37;&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Additionally Wen et al&#46; in 2014<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">28</span></a> evaluated the diagnostic value of <span class="elsevierStyleSup">99m</span>Tc-MDP SPECT in patients with clinically suspected CH&#44; based on the higher condylar activity in the affected side &#40;59&#37;&#41; against the contralateral &#40;41&#37;&#41;&#44; expressed by a differential uptake of the radionuclide&#46; This report is in agreement with Hooder et al&#46; &#40;2000&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">24</span></a> Kajan et al&#46; &#40;2006&#41;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">25</span></a> and Fahey et al&#46; &#40;2009&#41;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">22</span></a> and reports that differences of more than 10&#37; between condyles is indicative of UCH&#46; Considering the above summarized findings&#44; different therapeutic algorithms have been suggested by Hooder et al&#46; in 2000<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">24</span></a> and Rushinek et al&#46; in 2016&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">29</span></a> The surgical approach&#44; condylectomy of the affected side&#44; is suggested when the difference between condylar uptake of <span class="elsevierStyleSup">99m</span>Tc-MDP is more than 10&#37;&#46; The results of the present study show a dramatic change in the number of positive cases&#44; when fixed ROI are compared to variable ROI and when total counts are compared to normalized counts in variable ROIs as well&#46; This may be related to the fact that variable ROIs detect the total condylar uptake that is related to the grade of activity in the ossification nucleus and&#47;or to condylar size&#46; On the other hand&#44; a fixed ROI detects uptake in the area considered for both condyles&#46; Hence&#44; the method applied may significantly alter the therapeutic surgical decision&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">L&#243;pez et al&#46; in 2017<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">30</span></a> analyzed 51 SPECT images from patients with facial asymmetry and compared the value of qualitative reports&#44; based upon the subjective interpretation of a nuclear medicine expert&#44; versus quantitative reports obtained measuring radionuclide uptake in a region of interest &#40;ROI&#41; of each condyle&#46; The conclusion was that qualitative reports are less reliable than quantitative data &#40;percentage of agreement&#58; 39&#46;2&#37;&#41;&#46; The authors considered that the main limitation of quantitative reports is their inability to detect bilateral CH cases&#44; because the diagnosis is based on a 10&#37; difference between both sides in condylar uptake&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Therefore&#44; it is generally accepted that SPECT quantitative results are the best option available to detect hyperactivity in a condylar tissue&#46; But there is no consensus about the standardization of SPECT quantitative protocols&#44; to select the more reliable technical approach&#44; in terms of reproducibility and variability&#46; Pripatnanont et al&#46;&#44; 2005<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">17</span></a> studied 29 UCH patients to determine the finalization of mandibular growth&#44; using three methods for quantitative interpretation of SPECT results&#46; From a ROI located in the head of the condyle&#44; they measured the total radioactive counts&#44; the number of pixels and the normalized counts per pixel&#46; They concluded that the total counts are sufficient to establish the percentage of uptake in each condyle and distinguish active&#47;passive condylar growth stages&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Fahey et al&#46;&#44; <a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">22</span></a> evaluated radionuclide uptake in healthy subjects with no symptoms of CH&#44; using two techniques to interpret the data&#59; the first technique measured counts in a fixed-size ROI of 1&#46;13<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#44; considering the maximum values and the second technique measured activity in fixed ROIs obtaining the average of total counts in three transaxial sections&#46; Alsharif et al&#46;&#44; <a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">2</span></a> evaluated the diagnostic value of three quantitative techniques for SPECT interpretation in 33 patients with CH&#58; the first technique used a whole condyle approach&#44; measuring a variable ROI equal to the total volume of each condyle&#59; the second technique measured total counts in a fixed-size ROI &#40;1&#46;14<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41; drawn at the center of each condyle&#44; on a single transaxial image&#59; the third technique considered a fixed-size ROI &#40;1&#46;14<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41;&#44; but on five transaxial images&#46; They concluded that fixed-size ROI maximum counts and the percentage difference in condylar activity of 10&#37; as a cut-off provide the best combination of sensitivity&#44; specificity&#44; positive and negative predictive values&#46; Similar findings were obtained in the present study as no significant differences in the number of positive cases were detected using total counts vs normalized counts in fixed-size ROIs&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Additionally&#44; Rushinek et al&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">29</span></a> evaluated three approaches to SPECT analysis for the diagnostic of UCH&#44; in terms of sensitivity and specificity&#58; fixed-size ROI&#44; average volume of interest &#40;VOI&#41;&#44; and maximum VOI&#46; The specificity of these three approaches was respectively&#58; 77&#37;&#44; 65&#37;&#44; and 70&#37; with the same sensitivity &#40;88&#37;&#41; for all of them&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">All the above-mentioned investigations coincide with the present study about the advantage of fixed-size ROIs compared to variable ROIs&#46; In the present study&#44; the agreement between total and normalized counts is high for fixed-size ROIs &#40;97&#46;4&#37; of agreement&#44; Kappa 0&#46;940 and <span class="elsevierStyleItalic">p</span> 0&#46;000&#41;&#46; The diagnostic agreement between paired techniques is also favorable to fixed-size ROIs &#40;92&#46;1&#37; of agreement&#44; Kappa 0&#46;820 and <span class="elsevierStyleItalic">p</span> 0&#46;000&#41;&#44; but the difference between using 1 or 5 images is not relevant&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">However&#44; Kim et al&#46;&#44; <a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">31</span></a> and Vel&#225;squez et al&#46;&#44; <a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">32</span></a> provided evidence of anatomic differences between the deviated side and the contralateral side in patients with facial asymmetry&#46; As these differences affect the condylar shape&#44; articular eminence height and the projection of condyle within the articular fossa&#44; the use of only one transaxial slice might not be as representative as the summatory of a few transaxial tomographic slices&#44; to detect uptake differences between condyles&#46; Therefore&#44; anatomic differences should be considered in patients with facial asymmetry when the SPECT is used and interpreted&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">According to the results obtained by Alsharif et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">2</span></a> the technique using variable ROI and one image with normalized values presents the lowest variability&#44; as in the present study&#44; and provides 88&#37; of sensitivity and 87&#46;5&#37; specificity&#46; But when the variable-size ROI is applied to the total volume of condylar head&#44; the high sensitivity and specificity may depend on the variability in size of the condyle&#46; Lin et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">33</span></a> in a 3D evaluation of the condyle in patients with mandibular asymmetry reported that in fact the condylar size was increased in the asymmetric side&#46; Therefore&#44; the uptake of radionuclide may be influenced by the condylar size&#44; but as well may be due to the activity in the growth nucleus&#44; articular incongruence and the zone of photon scattering within the tissues&#46; In condyles of higher size&#44; the likelihood of false positive diagnostics could be increased&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Regarding intra-operator and inter-operator reproducibility&#44; the technique offering best reproducibility was the 5 image fixed-size ROI&#44; followed by the 1 image fixed-size ROI&#46; This finding is concordant with the study of Karssemakers et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">34</span></a> that in 67 SPECT images demonstrated a strong correlation between operators and a 100&#37; of agreement when total counts were used&#46; But in that study intra-operator repeatability was not measured and different quantitative techniques were not compared as in the present study&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">In variable-size ROI data&#44; the diagnostic difference obtained is notorious when total counts vs normalized counts are used&#46; Altogether&#44; our results suggest that the best technical option is the use of 5 image&#44; fixed-size ROI total counts when SPECT is applied for the diagnostic of UCH&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Using 5 images instead of only one&#44; as is common in previous studies&#44; is justified by the likelihood that the selected image may not be representative of the pathology&#46; In SPECT images&#44; reorientation of the volumetric image before selection of the slice is a critical issue&#46; The use of 5 images reduces errors related to a wrong selection of the area or its reorientation&#46; On the other hand&#44; variable ROIs are more dependent on the operator selection and interpretation&#44; and therefore tend to be more variable than fixed-size ROIs&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Finally&#44; the use of normalized counts&#44; assigning a constant value for each pixel within each ROI&#44; avoids the bias of selection when the area of highest uptake is selected&#46; However&#44; the use of normalized counts underestimates the zone of highest uptake because it redistributes the counts in pixels of less uptake and its value is not well defined because there are established normal values&#46; On the other hand&#44; the use of maximum total counts is less variable and more reproducible than normal counts&#44; but its high sensibility may cause more false positive results&#46; For this reason&#44; it is important that the diagnosis of CH should be made from an adequate correlation between facial and intraoral clinical characteristics with radiographic and&#47;or tomographic findings&#46; Being SPECT the only test providing information about the cellular metabolic activity of the suspected condyle&#44; in order to distinguish between an active or passive CH and&#47;or another entity&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">A limitation of the present study&#44; common to almost all the previous studies&#44; is that it does not provide data to correlate the condylar metabolic activity with morphologic condylar changes&#44; in order to improve specificity&#46; Another limitation is that real values of sensitivity and specificity could not be supported by histologic post-surgical data&#46; In similar studies sensitivity&#44; specificity and predictive values were obtained by clinical follow-up of the patients&#44; in absence of a histopathological gold standard&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">2</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">On the other hand&#44; it is well established that increasing sensitivity&#44; the specificity is reduced&#46; Therefore&#44; it is necessary to accept an intermediate compromise between the likelihood of obtaining false positive results and false negative results&#44; in a situation when both may have deleterious effects&#46; In this study the use of normalized counts detected less cases considered as positive for CH but total counts detected more positive cases&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">The correct quantitative assessment of the SPECT test will allow the development of studies related not only to the percentage of absorption between condyles&#44; but also with the absorption ratio in order to identify bilateral cases&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusions</span><p id="par0190" class="elsevierStylePara elsevierViewall">The comparison of four techniques to interpret SPECT results for the diagnostic of UCH suggests that the more reliable option is to use the method of 5 trans-axial slices&#44; fixed-size ROI and total counts&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Funding sources</span><p id="par0195" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public&#44; commercial&#44; or non-profit sectors&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of interest</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To compare variability&#44; reproducibility and repeatability of four quantitative evaluation methods to interpret the <span class="elsevierStyleSup">99m</span>Tc-MDP SPECT reports in patients with clinically suspected unilateral condylar hyperplasia &#40;UCH&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This was a descriptive observational study carried out with SPECT images of 38 patients with clinical and radiographic signs of UCH&#44; and interpreted using four quantitative methods&#58; &#40;1&#41; one image&#44; variable-size region of interest &#40;ROI&#41;&#59; &#40;2&#41; one image&#44; fixed-size ROI &#40;1&#46;76<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41;&#44; &#40;3&#41; five image variable-size ROI&#59; &#40;4&#41; five image&#44; fixed-size ROI &#40;1&#46;76<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41;&#46; Each of the images were report simultaneously but in an independent way by the two nuclear medicine experts in both total radioactive counts as well as normalized counts to quantify the reproducibility &#40;inter-operator variability&#41; and the repeatability &#40;intra-operator variability&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Higher reproducibility and repeatability were obtained in 5-image fixed-size ROI method &#40;intra-class correlation coefficient&#58; 0&#46;979 &#91;0&#46;959&#59; 0&#46;989&#93;&#41;&#46; A high grade of diagnostic agreement &#40;97&#46;4&#37;&#41; was also attained in fixed methods &#40;Kappa 0&#46;940&#44; <span class="elsevierStyleItalic">p</span> value&#58; 0&#46;000&#41; from either total or normalized counts&#46; There was no difference between fixed-size 1 vs 5 image methods&#46; The methods based on variable-size ROI had a low grade of agreement &#40;Kappa<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;20&#41;&#46; More positive cases were identified using one image&#44; ROI variable total counts &#40;27 cases&#41;&#44; but when the counts were normalized&#44; they presented a lower number &#40;5 cases&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Five-image fixed-size ROI provides the best intra-operator and inter-operator reliability for the diagnosis of unilateral condylar hyperplasia&#46; In the four methods using normalized counts fewer positive cases were detected &#40;&#8805;10&#37;&#41;&#44; unlike with total counts when more positive cases were found&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Comparar la variabilidad&#44; reproducibilidad y repetitividad de cuatro m&#233;todos de evaluaci&#243;n cuantitativa del SPECT con <span class="elsevierStyleSup">99m</span>Tc-MDP en pacientes con sospecha cl&#237;nica de hiperplasia condilar unilateral &#40;HCU&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional descriptivo&#44; realizado en 38 im&#225;genes SPECT de pacientes con signos cl&#237;nicos y radiogr&#225;ficos de HCU&#46; Estos fueron interpretados utilizando cuatro m&#233;todos cuantitativos de la prueba SPECT&#58; &#40;1&#41; Regi&#243;n objeto de inter&#233;s &#40;ROI&#41; variable de 1 imagen&#44; &#40;2&#41; ROI fija de 1&#44;76cm<span class="elsevierStyleSup">2</span> en 1 imagen&#44; &#40;3&#41; ROI variable de 5 im&#225;genes y &#40;4&#41; ROI fija de 1&#44;76cm<span class="elsevierStyleSup">2</span> en 5 im&#225;genes&#46; Cada una de las im&#225;genes fue le&#237;da simult&#225;neamente de forma independiente por dos m&#233;dicos nucleares tanto en sus cuentas totales como en las cuentas normalizadas para cuantificar la reproducibilidad &#40;variabilidad inter-observador&#41; de los m&#233;todos y la repetitividad &#40;variabilidad intra-observador&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Mayor reproducibilidad y repetitividad fue obtenida con el m&#233;todo de ROI fija de 1&#46;76cm<span class="elsevierStyleSup">2</span> en 5 im&#225;genes &#40;coeficiente de correlaci&#243;n intra-clase de 0&#44;979 &#91;0&#44;959&#59; 0&#44;989&#93;&#41;&#46; De igual forma se obtuvo un mayor grado de correspondencia diagn&#243;stica &#40;97&#44;4&#37;&#41; en los m&#233;todos fijos &#40;Kappa 0&#44;940&#44; valor <span class="elsevierStyleItalic">p</span>&#58; 0&#46;000&#41; tanto en cuentas totales como normalizadas&#46; No se encontraron diferencias entre ellos&#46; Los m&#233;todos basados en el an&#225;lisis de ROIs variables presentaron un menor grado de correspondencia &#40;Kappa<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;20&#41;&#46; El mayor n&#250;mero de casos positivos fue identificado utilizando una ROI variable de 1 imagen en cuentas totales &#40;27 casos&#41;&#44; pero al normalizar las cuentas presentaron el menor n&#250;mero &#40;5 casos&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">De acuerdo a la variaci&#243;n intra e interoperadores&#44; la t&#233;cnica de mejor repetitividad y reproducibilidad para el diagn&#243;stico de la hiperplasia condilar unilateral fue la ROI fija de 5 im&#225;genes&#46; En los cuatro m&#233;todos&#44; al usar cuentas normalizadas&#44; se detectaron menos casos positivos &#40;&#8805;10&#37;&#41; y con cuentas totales mas casos positivos&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; L&#243;pez Buitrago DF&#44; Mu&#241;oz Acosta JM&#44; C&#225;rdenas Perilla RA&#46; Comparaci&#243;n de cuatro m&#233;todos de valoraci&#243;n cuantitativa de 99mTC-MDP SPECT en pacientes con sospecha cl&#237;nica de hiperplasia condilar&#46; Rev Esp Med Nucl Imagen Mol&#46; 2019&#59;38&#58;72&#8211;79&#46;</p>"
      ]
    ]
    "multimedia" => array:14 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">ROI variable-size&#44; one image&#58; The image showing highest uptake was selected in both condyles&#46; A variable-size ROI was manually outlined&#44; including the total uptake area&#46; Maximum counts&#44; pixel number and average counts were obtained for that area&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Fixed size ROI one image&#58; The more active image was selected in each condyle and a fixed-size &#40;1&#46;76<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41; ROI was outlined on each condyle head to obtain maximum counts&#44; pixel number and average counts&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; The five transaxial slices with the highest condylar activity&#46; &#40;B&#41; The summed image of the five transaxial slices&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Fig&#46; 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Variable-size ROI image obtained from 5 trans-axial slices visualizing the condyles&#46;</p>"
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      ]
      4 => array:7 [
        "identificador" => "fig0025"
        "etiqueta" => "Fig&#46; 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr5.jpeg"
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            "Tamanyo" => 63708
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Fixed-size &#40;1&#46;76<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41; ROI image from 5 trans-axial slices visualizing the condyles&#46;</p>"
        ]
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      5 => array:7 [
        "identificador" => "fig0030"
        "etiqueta" => "Fig&#46; 6"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Bland&#8211;Altman graphs showing average differences and dispersion in the uptake percentage&#46; &#40;A&#41; Differences between variable-size ROI from using 5-images and 1-image methods&#46; &#40;B&#41; Differences between fixed-size ROI from using 5-images and 1-image methods&#46;</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
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        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Technique&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Definition&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Variable-size ROI<br>1 image&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">In a single transaxial slice with the highest condylar activity&#44; a variable-size ROI for each condyle keeping the trace of the contour to include total uptake was manually drawn &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fixed-size ROI 1 image&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">In a single transaxial slice with the highest condylar activity&#44; a fixed-size ROI &#40;1&#46;76<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41; on each condylar head was positioned &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Variable-size ROI<br>5 image&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">In a image obtain by the summed of five transaxial slices&#44; a variable-size ROI for each condyle keeping the trace of the contour to include total uptake was manually draw&#46; &#40;<a class="elsevierStyleCrossRefs" href="#fig0015">Figs&#46; 3 and 4</a>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fixed-size ROI 5 image&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">In a image obtain by the summed of five transaxial slices with the highest condylar activity&#44; a fixed-size ROI &#40;1&#46;76<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#41; on each condylar head was positioned&#46; &#40;<a class="elsevierStyleCrossRefs" href="#fig0015">Figs&#46; 3 and 5</a>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "imagenFichero" => array:1 [
                0 => "xTab1976503.png"
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Definition of quantitative techniques&#46;</p>"
        ]
      ]
      7 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
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            "identificador" => "at2"
            "detalle" => "Table "
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Technique</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Total counts</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Normalized counts&#47;pixels</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Right condyle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Left condyle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Right condyle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Left condyle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Variable-size ROI 1 image</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dahlberg <span class="elsevierStyleItalic">S</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#91;95&#37; CI&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;880 &#91;0&#46;959&#59; 0&#46;989&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;880 &#91;0&#46;778&#59; 0&#46;937&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;884 &#91;0&#46;788&#59; 0&#46;938&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;884 &#91;0&#46;788&#59; 0&#46;938&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Fixed-size ROI 1 image</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dahlberg <span class="elsevierStyleItalic">S</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#91;95&#37; CI&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;856 &#91;0&#46;738&#59; 0&#46;923&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;891 &#91;0&#46;797&#59; 0&#46;942&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;891 &#91;0&#46;797&#59; 0&#46;943&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;891 &#91;0&#46;797&#59; 0&#46;943&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Variable-size ROI 5 image</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dahlberg <span class="elsevierStyleItalic">S</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#91;95&#37; CI&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;810 &#91;0&#46;661&#59; 0&#46;898&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;810 &#91;0&#46;661&#59; 0&#46;898&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;837 &#91;0&#46;703&#59; 0&#46;913&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;837 &#91;0&#46;703&#59; 0&#46;913&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Fixed-size ROI 5 image</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dahlberg <span class="elsevierStyleItalic">S</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#91;95&#37; CI&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;979 &#91;0&#46;959&#59; 0&#46;989&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;979 &#91;0&#46;959&#59; 0&#46;989&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;975 &#91;0&#46;953&#59; 0&#46;987&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;975 &#91;0&#46;953&#59; 0&#46;987&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1976505.png"
              ]
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Inter-operator reproducibility using total and normalized counts for each condyle&#46;</p>"
        ]
      ]
      8 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Technique</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Total counts &#8211; right condyle</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Normalized counts&#47;pixel &#8211; left condyle</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Operator 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Operator 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Operator 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Operator 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Variable-size ROI 1 image</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dahlberg <span class="elsevierStyleItalic">S</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#91;95&#37; CI&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;899 &#91;0&#46;728&#59; 0&#46;965&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;859 &#91;0&#46;627&#59; 0&#46;952&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;892 &#91;0&#46;717&#59; 0&#46;962&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;814 &#91;0&#46;517&#59; 0&#46;936&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Fixed-size ROI 1 image</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dahlberg <span class="elsevierStyleItalic">S</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#91;95&#37; CI&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;984 &#91;0&#46;944&#59; 0&#46;995&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;929 &#91;0&#46;713&#59; 0&#46;979&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;982 &#91;0&#46;949&#59; 0&#46;994&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;899 &#91;0&#46;723&#59; 0&#46;966&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Variable-size ROI 5 image</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dahlberg <span class="elsevierStyleItalic">S</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#91;95&#37; CI&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;957 &#91;0&#46;872&#59; 0&#46;986&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;666 &#91;0&#46;247&#59; 0&#46;878&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;903 &#91;0&#46;741&#59; 0&#46;966&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;832 &#91;0&#46;582&#59; 0&#46;939&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Fixed-size ROI 5 image</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dahlberg <span class="elsevierStyleItalic">S</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#91;95&#37; CI&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;991 &#91;0&#46;945&#59; 0&#46;994&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;998 &#91;0&#46;994&#59; 0&#46;999&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;982 &#91;0&#46;945&#59; 0&#46;994&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;999 &#91;0&#46;996&#59; 0&#46;999&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1976502.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Repeatability &#40;intra-operator reproducibility&#41; using total and normalized counts&#46;</p>"
        ]
      ]
      9 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Technique</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Total counts</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Normalized counts&#47;pixel</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Right condyle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Left condyle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Right condyle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Left condyle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Variable-size ROI 1 image</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Average<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Fixed-size ROI 1 image</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Average<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Variable-size ROI 5 image</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Average<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Fixed-size ROI 5 image</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Average<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Uptake percentage using total and normalized counts&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Technique&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total counts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Normalized counts&#47;pixel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#37; of agreement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Kappa &#40;<span class="elsevierStyleItalic">p</span> value&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Variable-size ROI 5 image&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;201 &#40;0&#46;044&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fixed-size ROI 5 image&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;940 &#40;0&#46;000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Variable-size ROI 1 image&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;116 &#40;0&#46;062&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fixed-size ROI 1 image&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;943 &#40;0&#46;000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Techniques compared&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#37; of agreement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Kappa &#40;<span class="elsevierStyleItalic">p</span> value&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="6" align="left" valign="top">Total counts</td><td class="td" title="table-entry  " align="left" valign="top">Variable ROI 5 image vs fixed ROI 5 image&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;593 &#91;0&#46;409&#59; 0&#46;777&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;129 &#40;0&#46;208&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Variable ROI 5 image vs variable ROI 1 image&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;301 &#91;0&#46;077&#59; 0&#46;524&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;395 &#40;0&#46;002&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Variable ROI 5 image vs fixed ROI 1 image&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;535 &#91;0&#46;314&#59; 0&#46;757&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;079 &#40;0&#46;309&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fixed ROI 5 image vs variable ROI 1 image&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;277 &#91;0&#46;120&#59; 0&#46;434&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;349 &#40;0&#46;002&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fixed ROI 5 image vs fixed ROI 1 image&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;889 &#91;0&#46;825&#59; 0&#46;954&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;828 &#40;0&#46;000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Variable ROI 1 image vs fixed ROI 1 image&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;307 &#91;0&#46;129&#59; 0&#46;486&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;289 &#40;0&#46;012&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="6" align="left" valign="top">Normalized counts&#47;pixel</td><td class="td" title="table-entry  " align="left" valign="top">Variable ROI 5 image vs fixed ROI 5 image&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;300 &#91;0&#46;064&#59; 0&#46;536&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;494 &#40;0&#46;000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Variable ROI 5 image vs variable ROI 1 image&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;142 &#91;&#8722;0&#46;082&#59; 0&#46;367&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;539 &#40;0&#46;000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Variable ROI 5 image vs fixed ROI 1 image&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;282 &#91;0&#46;020&#59; 0&#46;545&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;451 &#40;0&#46;000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fixed ROI 5 image vs variable ROI 1 image&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;729 &#91;0&#46;597&#59; 0&#46;861&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;349 &#40;0&#46;006&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fixed ROI 5 image vs fixed ROI 1 image&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;916 &#91;0&#46;868&#59; 0&#46;965&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;821 &#40;0&#46;000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Variable ROI 1 image vs fixed ROI 1 image&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;724 &#91;0&#46;606&#59; 0&#46;841&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;451 &#40;0&#46;000&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "mostrarDisplay" => true
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          "Fichero" => "STRIPIN_si2.jpeg"
          "Tamanyo" => 6590
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